PRE 2010 DOCSr
Villa"gaebf Fridley, Minn. I
BUILDING PERMIT N? 1633
.4
Date: tee..........
OwnerK Builder ..............................................
Address...................................... Address .............................................
LOCATION OF BUILDING
No. 7.
.... Street ..... Part of L9V ...............................
Lot ......... Block ................... Addition or Seib -Division : .................
Comer Lot ........... Inside Lot Setback Sideyard ...;L r.)
..........................
DESCRIPTION OF BUILDING
1.7o be Used as-.
A
Depth ........ Height Ft. ........ Cu. Ft. ........
M 1�ront ........ Depth ........ Height ........ Sq. Ft. ........ Cu. Ft. ........
-7)
Type of Cons ion Est. Cost
.............. `. . s. To be Completed ..................
In consideration of the issuance to me of a permit to
76h -
the proposed work in accordance with W IQ
ordinances of the village Qf Fridley. W-
'� '
the building described above, I agree to do
ir*joln compliance with all provisions of
-7
.. ..........................................
1-1 -
f-�i ' I
I , , - " t,41
In consideration of the payment of a fee o ... , permit is hereby granted to ( ...........I.
......................... to construct the 'building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
....... Building Inspector
NOTICE:
This permit does not cover the construct -Ion, Installation or alteration for wl 71plumbing, gas heating,
h-'�
sewer or water. Be sure to see tIding Inspector for separate permits for items.
City of Fridley, Minn.. N° 8143
BUILDING PERMIT
Date: July 7s 1965
Owner: Richard Dean Builder Marvin A. Eisen
Address 620 Mississippi Street N. E. Address 1144 winnetka Ave. No.
LOCATION OF BUILDING
No. 620 Street 11i.ssissippi Street N. B. ____ Part of Lot
Lot rL__ Block 2 Addition or Sub.Division Christie glad n.
Corner Lot _ Inside Lot _ Setback Sideyard
Sewer Elevation Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Front Depth Height Sq. Ft Cu. Ft
Front Depth Height Sq. Ft Cu. Ft
Type of Construction Est cost $1,200.QQ To be completed
Storm damage repair
rn consideration of the issuance to me of a permit to construct the building described above I agree to do
the proposed work in accordance with the description above set forth and in compliance with a& provisions of
ordinances of the city of Fridley. _ _ A ,
In consideration of the payment of a fee of1$ 0a , permit is hereby granted A. Elsen
to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alat maintenance, repair
oPany of the provand moving isions of buildinsm
visions of said
wior thin cesthe city limits and this any time upono
Men Jensen Building i2spector
NOTICE
Yids permit does not ewer the condrudion, hutalls m for whdng, plumbing, ges heating, sewer or water. Be sure to see
the Building Nestor for separate permits for these hems. - - -
APPLICATION FOR BT�II.DING PERMIT
Oil CITY OF FRIDLEY, Afin=s0TA
z.
OWNER'S NAME f G ice% I7 �//�% BUILDER V//t% �LJl✓
ADDRESS /,42 ®A%/sS I s-5 le /- 5 TAj, �Or. ADDRESs� ®W'/il��ii
LOCATION OF BUILDING
-i /Stree Part of Lot
LOT ADDITION OR SUBDIVISION/.5 7 �f�,�Je°�/J
Corner Lot Inside LOT P'00' Setback, _ Sf",Ya-d_,_ � ® r
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To be used as;���°`
G' ..Front � Deptb, � -v-' eight
Sq. Ft. Cu. Ft.
Front Depth `.Height
Sq. Ft. Cu. Ft.
Type of Construction Estimated Cost
To be completed
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordance with the City of Fridley Ordinances
and rulings of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
DA -S S SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
47- 4A
846ekA
u
C= • , ���2�y1; <��� � � � o 11.E w
it, V. (!��
(J ® r
d-Alrnwele�l "-v4��
6'
PgrZAr °
ple
14
d�rgec v n/,E6J
Room
a
° 1
r r°•
/—L , °', Bko cw 2
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
'
PLUMBING FIXTURE RATES: NO,
' °°
TOTAL
irls.:ber Fixtures ,
•�
�.:
n
Future -Fixture Opening •_
�
m
S
Water
x
$2.00
S
Catch Basin
x
$5.00
$
Water Heater - to 99,000 BTU,
'
$5.00
$
-Z
100-000 BTU to 199,000 BTU
x
$10.00
$
Water Softener
Heater
$7.90
$
'
x
$5.00
$
N
x
$5.00
S
GAS FITTING PEES:
N
N
x
$3.00
$
p
p
.�
a�j
a
C
H
$10.00
..►
au.
0
a
w
m
899o,
u h
�
�
�
0
as
Inec
y
ru
State surcharge
�$
,
TOTAL FEE
$ , • 8.00
1st
2nd
3rd
.
- Future Connection Opening
ff
Connected with Sewer
- New Fixture, Old Opening
Water
-PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO,
RATE
TOTAL
irls.:ber Fixtures ,
x
$3.00
S
Future -Fixture Opening •_
x
$2.00
S
Now Fixture, Old Opening __
x
$2.00
S
Catch Basin
x
$5.00
$
Water Heater - to 99,000 BTU,
'
$5.00
$
-Z
100-000 BTU to 199,000 BTU
x
$10.00
$
Water Softener
x '
$7.90
$
New Ground• Run old Building �_
x
$5.00
$
Electric Water Heater
x
$5.00
$
GAS FITTING PEES:
1st 3 fixtures
x
$3.00
$
Additional Fixtures
x
$1.00
$
.Gas Range to 199,000 BTU
x
$10.00
$ _
REPAIRS $ ALTERATIONS
First $100.00
55.00
each add. $100.00 or traction
$2.00
$ ^_
State surcharge
$ .50
TOTAL FEE
$ , • 8.00
Job Address
620 MISSISSIPPI STREET
Department of Buildings
City of Fridley
Tel. #571-3450
The undersigned hereby makes application for a permit for the work herej
specified agreeing -to do all work in'strict accordance with the City Code
and rulings of the Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and cor
Fridley, M.•ti. 2-8-77 , 19_�
OWNER RICHARD DEAN
KIND OF BUILDING frame
USED AS res.
TO BE COMPLETED ABOUT 2-15-71
ESTIMATED COST 10.00
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
Company �Gy yi d' Ce
Signed By MINNEGASCO
Tel. No.
ROUGH INSP.
Date
FIN4L INSP. -
Date
APPROVAL FOR PERMIT 4el46J .
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50
Class ,A,, Surcharge .50g
REINSPECTION FEE ,
($]0.00)
SUBJECTj7�155
City of Fridley
6 5 3
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
R
i �
. COMMUNITY DEVELOPMENT DIV.
1 LV ������
r PROTECTIVE INSPECTION SEC.
1 � �
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
4/10/80
JOB ADDRESS 620 Mississippi. Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
55
2
Christie's Addition SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Richard Dean 620 Mississippi Street N.E. 571-3868
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 14' x 8' Shed
9 CHANGE OF USE FROM TO
STIPULATIONS Shed to be 3' from lot line (.or off an easement) and on a permanent
foundation or tied down permanently with ties).
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$250
$.50
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$7.50
PLAN CHECK FEE
TOTALFEE
$8.00
SI 7i1REOFCONTRACTORORAUTHORIZEDAGENT I ATE)
WHEN PROPERLY ALIDATEDIS YOUR PERMIT
+y
�`
rypTHIS
BLDG INSP DATE
,✓/
Si NATURE OF OWNER IIF 0WNER BUILDERi (DATE)
CITY OF f=RIDLEY
APPLICATIO,d FOR RESIDENTIAL BUILDING PERMITS
(!deur, Alterations, A(ldiftions, or Repairs)
OWNER- icln�&- 00e&. BUILDER:
ADDRESS: ADDRESS:
TEL NO: ��/^� r fEL 140:
Construction Location
STRIMT NO: STREET: /n-"S^S�''SS )f/
LOT: BLOCK : ,�- ADDITION:
Corner_ Lot: Inside Lot: h,, _ Setklack: r Sideyards: _
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTIO14 OF CONSTRUCTION
Front: r Depth: I Height:
Square Feet:_ Cubic Feet: 91(a
Front:
Depth: Height:
Square- Feet: Cubic Feet:
Type of Construction: �S' /
'Ib Be Completed: as" —so
Proposed. Driveway Width If New Opening Is Desired:
Estimated Cost:
Alt. A Alt. B
SEE REVERSE SIDE OF SHEET
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordance with the City of. Fridley Ordinances and
rulings of the Department of Buildings, and hereby declares that all the facts and
representations stated in this application ar-c true and correct.
OI I/A "�
DATE: y SIGNATU
Stipulations:
L'
CITYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY. MN 55432 • (612) 571-3450 • FAX (612) 571-1287
November 20, 1991
Clinton and Brenda Tibbetts
620 Mississippi Street N.E.
Fridley, MN 55432
RE: First Notice of Noncompliance at 620 Mississippi Street
Dear Mr. and Mrs. Tibbetts:
The City of Fridley has established a City Code for the purpose of
promoting a pleasant and attractive suburban environment. A recent
inspection of the property at 620 Mississippi Street revealed that
not all Code requirements are presently being met. Listed below
are items which do not comply with the City Code:
1. Discontinue outside storage of basketball hoop, tractor,
barrels, and assorted materials located on and near utility
trailer along east side of garage. (Fridley Zoning Code does
permit the utility trailer itself to remain at this location.)
Your prompt attention in correcting this situation would greatly
assist us in helping make Fridley a better place to live. An
inspection will be conducted on or about December 9, 1991, to
determine compliance.
If you have questions or would like to discuss this, please contact
me at 572-3595. Thank you for your cooperation!
Sincerely,
Steven Barg
Code Enforcement Officer
SB:ls
CE -91-491
G7YOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287
November 25, 1996
Clinton Tibbetts
620 Mississippi Street
Fridley, MN 55432
RE: First Notice of Noncompliance at 620 Mississippi Street
Dear Mr. Tibbetts:
The City of Fridley has established a City Code for the purpose of promoting a pleasant
and attractive suburban environment. A recent inspection of the property at 620
Mississippi Street revealed that not all Code requirements are presently being met.
Listed below are items which do not comply with the City Code:
• Fridley City Code requires that all vehicles must be currently licensed, street
operable, and kept on a hard surface parking area if they are stored outside. I
observed an improperly parked vehicle at this location. Please place all vehicles
on the hard surface driveway immediately.
• Please discontinue outside storage of materials including, but not limited to, a
door and miscellaneous scrap wood and debris located in the driveway and side
yard area.
Your prompt attention in correcting this situation would greatly assist us in helping
make Fridley a better place to live. An inspection will be conducted on or shortly after
December 10, 1996, to determine compliance.
If you have questions or would like to discuss this violation, please contact me at 572-
3595. Thank you for your cooperation!
Sincerely,
�j
bvv ,N✓ ( � J �'i,
u nsen-Schneider
Code Enforcement Officer
KJS:Is
CE -96-472
SUBJECT
City of Fridley
25 3 3.
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
N0.
I _ COMMUNITY DEVELOPMENT DIV.
~ PROTECTIVE INSPECTION SEC.
1 ,
NUMBER
REV
DATE
7/30/97
PAGE Of
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
JOB ADDRESS 620 Mississippi Street NE
1 LEGALLOT
NO,
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
5
2
I
Christie Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Clinton/Brenda Tibbetts 620 Mississippi Street NE
572-0358
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION Ek REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (25 sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS Underlayment must comply with the State
Building Code.
TYPE OF CONST,
OCCUPANCY GROUP
OCCUPANCYLOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$2,086
$1.04
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$74.75
Fire SC. $2.09
STRUCTIO OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
77.88
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT MATEI
WHEN PROPERL ALIDATED THIS IS YOUR PERMIT
>
LD INSP
- 3l
GATE
_
SIGNATURE OF OWNER OF OWNER BUILDER, IDATEI
NEW
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:�
Legal Description:
Effective 1/1/97
Owner Name & Address: /,�j�,�, �j`i' , z Tel. # S T,;:� -0�55r F'
Contractor: ,S'- / -P MN LICENSE #
Address:
I
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Tel. #
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width . Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Construction Type: �,r' Estimated Cost: $ �d, G'�o
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Rix $ _ $
DATE: D " APPLICANT: Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ 7.7,5!
$ x.09.
$ X. 4
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$950 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] . Not Necessary [ ]
SUBJECT
City of Fridley
29072
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r?
RECEIPT NO.
` v------ COMMUNITY DEVELOPMENT DIV.
� INSPECTION SEC.
/Z/W
f � PROTECTIVE
NUMBER
REV
DATE
PAGE OF
APPROVED By
CITY HALL FRIDLEY 55432
L 612-571-3450
910-F15
3/25/99
JOB ADDRESS
620 MiSSiSSiDDi Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
5
2
1 Christie Addition
SHEET
2 PROPERTY OWNER MAIL ADORE"
ZIP PHONE
Clinton Tibbetts 620 Mississippi Street NE
572-0358
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Town & Country Roofing
-
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO,
20091282
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
B USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION O ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
X
8 DESCRIBE WORK
Reroof House & Garage 24 SO Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday
thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING,
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT
CU FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$2,056
$1.03
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
Fire
STRUCTION OR THE PERFORMANCE OF CONSTR ION
/PC
PLAN CHECK FEE//
TOTA F E
Old 3 1aci
L i c S $5.0
$82.84
SIGNATURE OF CON7AACTOR OR AUTHORIZED AGENT IDATEI
EN PR P
VALIDAT D HIS IS YOUR PERMIT
S,GNATURE OF OWNER -If OWNER BUILDER- IOATEI
BL GOt -NSP If
OA TE
Mar -19-99 11:24A
NEW []
P.14
Effective 1/1/98
ADDN (J CITY OF FRIDLEY
ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
cam-
ConstructionAddress: �c2o I, 5-"2;S-3 4a0 i S r rit C-_
Legal Description:?_ - G±" 4- r c- - rLn
Owner Name & Address: Tel. # 6 22
Contractor:�.4.ri "�MN LICENSE # d ,77/x$_' oZ
0 -5 -
Address: L.) IQ Ao,-1oe t Tel. #
Attach to this application, a Certificate of S(rvey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
Construction Type: tom— cno-f Estimated Cost: $
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
(Fee Schedul
Ft x $
Sq. Ft.
Sq. Ft.
Sq. Ft.
on Back)
=$
DATE: APPLICANT: Tel. # cgs 3--9 S (a
TOTAL $
STIPULATIONS:
CITY USE ONLY
Permit Fee
$
Fee Schedule on Reverse Side
Fire Surcharge
$ c2,e oQ
.001 of Permit Valuation (1/10th%)
State Surcharge
$ ZoQ,5
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$ r„�,aL)
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $
STIPULATIONS: